CONTEXTE : La France est caractérisée par l’existence de fortes disparités socioéconomiques et géographiquesde l’état de santé, le plus souvent objectivées par des indicateurs objectifs de morbidité et de mortalité. Ladistribution territoriale des mesures de santé perçue comme la qualité de vie liée à la santé (QdVLS) reste malconnue en population générale. Une meilleure connaissance de la répartition et des déterminants – en particuliercontextuels - de ces indicateurs subjectifs permettrait de mieux comprendre leur signification par rapport auxindicateurs objectifs et d’apprécier l’intérêt spécifique de leur suivi en population générale.OBJECTIFS : Les objectifs de cette recherche étaient [1] d’étudier l’existence de disparités spatiales de QdVLSdans la population française et d’analyser leur évolution dans le temps, [2] d’étudier les déterminants de laQdVLS à la fois individuels et contextuels dans le cadre d’une analyse multiniveau, et [3] d’évaluer lesassociations écologiques entre QdVLS et mortalité ultérieure à cinq ans d’intervalle.MATERIEL ET METHODES : Les données issues de deux enquêtes transversales nationales représentatives ont étéexploitées : l’enquête Décennale 2003 de l’Insee pour l’ensemble des travaux menés (N=22 743 [1 et 3] ; N=16 732 [2]) et l’enquête Sofres 1995 pour l’analyse de l’évolution temporelle de la QdVLS (N=3 243 [1]). Lequestionnaire utilisé dans les deux enquêtes était le SF-36. [1] Des modèles de régression linéaire multiple àeffets fixes avec recherche d’interactions ont été réalisés pour l’analyse de l’évolution temporelle. [2] L’analysemultiniveau des déterminants contextuels de la QdVLS s’appuyait sur des modèles à effets mixtes, afind’explorer une chaine causale incluant des déterminants aux niveaux individuel, du ménage, de l’unité urbaine etrégional, d’ordre démographique, socioéconomique ou intégrant la notion contextuelle plus complexed’attractivité (taux migratoire, désindustrialisation). [3] Les données de mortalité étaient issues de la statistiquenationale des décès élaborée annuellement par le CépiDc. Des modèles de régression binomiale négative ont étéréalisés pour l’analyse des associations écologiques au niveau régional entre QdVLS en 2003 et mortalitéultérieure (court terme [2003-2005] ; à 5 ans [2007-2009]) et en stratifiant sur le sexe, l’âge et les causesspécifiques de décès.RESULTATS PRINCIPAUX : [1] Une diminution significative de la QdVLS était observée entre 1995 et 2003affectant tous les groupes sociodémographiques et suggérant la possibilité d’un accroissement des disparités pourles catégories les plus fragiles de la population. [2] De fortes disparités régionales de QdVLS étaient retrouvées,persistant après ajustement sur les caractéristiques socioéconomiques individuelles. L’analyse multiniveaupermettait d’identifier des processus de médiation impliquant les variables contextuelles de désindustrialisation,le taux d’accroissement migratoire, le taux d’abstention aux élections, et les comportements liés à la santé. Desinteractions inter-niveaux et intra-régionales étaient identifiées. [3] Des associations écologiques significativesétaient retrouvées au niveau régional entre QdVLS et mortalité à cinq ans d’intervalle, persistant aprèsajustement sur le niveau socioéconomique. Des relations spécifiques étaient observées après stratification surl’âge, le genre, les causes spécifiques de décès ; le caractère prédictif de la QdVLS variait selon le délai plus oumoins court entre mesure de la QdVLS et mortalité. / BACKGROUND: Wide social and geographical disparities are reported in France for morbidity and mortalityindicators. Less is known regarding the spatial distribution in general population of self-rated health (SRH) andhealth-related quality of life (HRQoL). Improving the knowledge of the contextual determinants of HRQoLwould help towards a better understanding of their meaning and interest in general population when it comes tocompare with classical objective indicators.OBJECTIVES: The objectives were [1] to assess existing spatial disparities of HRQoL in French generalpopulation and to investigate their evolution in time, [2] to determine individual and contextual determinants ofHRQoL and [3] to explore the ecological associations between HRQoL and subsequent mortality five years later.METHODS: Data were drawn from two large representative cross sectional surveys: the Insee Decennial HealthSurvey led in 2003 (N=22 743 [study 1 and 3] ; N= 16 732 [2]) and the Sofres health survey led in 1995(N=3243 [1]).The MOS SF-36 questionnaire was used in both surveys. [1] Fixed effects linear models combinedwith interaction tests were used for assessing time trends. [2] Mixed effects linear models were used for themultilevel analysis, exploring a causal pathway including individual and macrolevel factors (household, urbanunit and region) assessing demographics, socioeconomics, and features related to the notion of areaattractiveness (deindustrialization, net migration rates). [3] Mortality data were drawn from the French nationalstatistics of mortality (CepiDc-Inserm). Negative binomial regression models were performed to identifyecological associations at the region level between HRQoL recorded in 2003 and subsequent mortality (shortterm [2003-2005]; 5-years later [2007-2009]), stratifying on age, gender and specific causes of death.MAIN RESULTS: [1] A significant decrease in HRQoL was observed between 1995 and 2003, affecting allsociodemographic categories and suggesting likely widening disparities in the most fragile categories. [2]Regional HRQoL disparities were found, persisting after adjusting on socioeconomic individual characteristics.Multilevel analysis showed some evidence for mediation involving contextual factors like deindustrialization,net migration rates, voter abstention rate and health-related behaviors. Cross-level interactions were found aswell. [3] Significant ecological associations were identified at the region level between HRQoL and mortalityfive years later, persisting after adjusting on deprivation. Specific relationships were observed after stratifying onage, gender, specific causes of death; the predictive ability of HRQoL for mortality was varying depending onthe mortality period considered for analysis.CONCLUSIONS: Our results highlight the interest in assessing HRQoL at the population level and in exploringthe contextual determinants at play. Systematic inclusion of validated and multidimensional HRQoLquestionnaires should be supported in national surveys, so as to improve our knowledge of long term temporaltrends in HRQoL, to promote an increased use of contextual multilevel analyses using such data, and eventuallyto help better identifying sub-groups at risk and optimizing public health interventions.

Today, many organisations are adopting offices that have an open design with or without flexible seating. While advocates of open-plan offices propose that these office types lead to cost savings and aid inter and intra-team communication, opponents argue that these office types are associated with decreased performance and worsened health among employees. This thesis investigates how the type of office (cell offices, shared room offices, small open-plan offices, medium-sized open plan offices, large open-plan offices and flex offices) influences employee health and performance, and whether this is different for different personalities and jobs with different concentration demands. Data were gathered by means of surveys and cognitive tests from five organisations with different office types. In Study I (N=1241), the aim was to investigate the main effect of office type on indicators of health and performance and the interaction effect of office type with the need to concentrate in order to carry out work tasks. Office type alone was associated with distraction and cognitive stress in such a way that cell offices were associated with fewest problems, followed by flex offices, while open-plan offices were associated with the most problems. While employees in open-plan offices and employees in flex offices reported more problems as the need for concentration increased, employees in cell offices reported the same level of problems regardless of the need of concentration. Study II (N=527) investigated how performance on a memory test was affected during normal working conditions as compared to a quiet baseline. There was a negative dose-response relationship between the size of the open-plan office environment and the drop in word recall during the normal working condition. However, Study II also showed that individuals working in cell offices had as high a drop in performance during normal working conditions as did those working in large open-plan office environments. Study III (N=1133–1171) focused on the interaction effect between office type and individual differences in personality. The personality trait agreeableness interacted with office type on the outcome variables distraction and job satisfaction. Specifically, Study III may indicate that as offices get more open and flexible, agreeable people will report more problems. In conclusion, the studies in the present thesis have implications for practice and suggest that office type impacts on employee health and performance, while concentration demands of the job and agreeableness moderate the effects. Although employees report higher level of distraction in open-plan office environments, when performance on a demanding task is measured, cell offices are not as favourable during normal working conditions as self-reported data usually indicate. Organisations should also be aware that, among open-plan offices, small open-plan offices are associated with fewer problems. / Kontorslandskap med eller utan fasta arbetsstationer förekommer idag i många organisationer. Förespråkare för kontorslandskap hänvisar till kostnadsbesparing samt förbättrade förutsättningar för kommunikation, medan motståndare hävdar att kontorslandskap leder till försämrad prestation och hälsa bland medarbetarna. Denna avhandling undersöker om kontorstyp påverkar de anställdas hälsa och prestation, samt om effekten av kontorstyp varierar beroende på de anställdas personlighet och typ av arbetsuppgifter. Data i form av enkätsvar och prestation på kognitiva tester samlades in från fem organisationer med olika typer av kontorslösningar (cellkontor, delade kontorsrum, små kontorslandskap, mellanstora kontorslandskap, stora kontorslandskap och flexkontor). I studie I (N = 1241) var syftet att undersöka huvudeffekten av kontorstyp på indikatorer för hälsa och prestation samt om effekten är beroende av koncentrationskraven i arbetet. Kontorstyp visade samband med distraktion och kognitiv stress på så sätt att medarbetare i cellkontor uppgav minst problem, följt av de i flexkontor, medan kontorslandskap var förknippade med mer problem. Vidare rapporterade anställda som hade arbetsuppgifter som krävde koncentration mer problem i kontorslandskap och flexkontor, medan anställda i cellkontor, oavsett arbetets krav, rapporterade lika mycket problem. I studie II (N = 527) undersöktes hur prestation på ett minnestest påverkades under normala arbetsförhållanden jämfört med en tyst referensmätning i olika kontorstyper. Det fanns ett negativt dos-responssamband mellan storleken på kontorslandskapet och hur många procent sämre medarbetare presterade under normala arbetsförhållanden. Men Studie II visade också att personer som arbetar i cellkontor hade ett lika högt bortfall i prestation under normala arbetsförhållanden som de som arbetade i stora kontorslandskap. I studie III (N = 1133-1171) låg fokus på interaktionseffekten mellan kontorstyp och personlighet. Vänlighet var den enda personlighetsvariabeln som interagerade med kontorstyp på utfallsvariablerna distraktion och arbetstillfredsställelse. Mer specifikt visade Studie III att när kontoret blir mer öppet och flexibelt, så rapporterar människor som skattar sig högt på personlighetsvariabeln vänlighet fler problem. Resultaten i avhandlingen kan få flera praktiska implikationer då den visar att kontorstyp påverkar medarbetarnas hälsa och prestation, medan koncentrationskrävande arbetsuppgifter och vänlighet modererar effekterna. Vidare visar avhandlingen att även om anställda rapporterar mindre distraktion i cellkontor jämfört med i kontorslandskap, behöver inte cellkontor vara lika gynnsamma som självskattade mått visar när prestationen mäts med objektiva mått under normala arbetsförutsättningar, i det här fallet ett minnestest. Slutligen bör organisationer även vara medvetna om att avhandlingen visar en viss tendens att små kontorslandskap är förknippade med mindre problem än stora. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 3: Manuscript.</p>

Syfte och frågeställningar Syftet med studien var att undersöka samband mellan socialt stöd och nätverk gentemot upplevd fysisk och psykisk hälsa hos gymnasielever i årskurs tre. Frågeställningarna var huruvida det fanns några samband mellan socialt stöd och nätverk gentemot upplevd fysisk och psykisk hälsa, vilken form av socialt stöd och nätverk som var mest relevant och vilken roll dess storlek har, samt om det fanns några skillnader mellan könen i förhållandet till socialt stöd och nätverk. Metod Undersökningen är en explorativ och kvantitativ enkätstudie där totalt 326 individer från olika skolor i Eskilstuna, Stockholm och Filipstad ingick. Åldern på deltagarna varierade mellan 17 och 21 år och medelålder var 18 (±0,7) år. 198 var tjejer och 123 killar, fem personer ville ej svara på frågan eller uppfattade sig inte som något av alternativen. Deltagarna besvarade frågor med fasta svarsalternativ kring kvalitén på sitt sociala stöd och storleken på sitt sociala nätverk, samt om upplevd fysisk och psykisk hälsa. Därefter genomfördes olika korrelationsobservationer för att finna eventuella samband mellan de olika faktorerna. Deltagarna till studien har valts utifrån ett icke slumpmässigt, till viss del typiskt, bekvämlighetsmässigt urval. Resultat Signifikanta positiva samband noterades mellan graden av socialt stöd (kvalitet) och upplevd psykisk respektive fysisk hälsa. Starkast korrelation fanns mellan psykisk hälsa och socialt stöd (r = 0,46). Svaga positiva korrelationer fanns mellan antalet (kvantitet) vänner (r = 0,19) respektive familjemedlemmar och släktingar (r = 0,19) gentemot psykisk hälsa, och i förhållande till familj och släkt även den fysiska (r = 0,14). Inga signifikanta skillnader kunde ses mellan könen. Slutsats Studiens hypotes om en positiv samvariation mellan upplevd hälsa och socialt stöd och nätverk stämde i de flesta fall och kvalitet visade sig vara överordnad kvantitet. / Aim The purpose of this study was to examine relations between social support and networks, against the perceived physical and mental health of high school students in grade three. The question formulations were whether there was any correlation between social support and networks against perceived physical and mental health, which form of social support and network that were most relevant and what role its size has, and if there were any gender differences in relation to social support and networks. Method The study is an exploratory and quantitative survey in which a total of 326 individuals were included from various schools in Eskilstuna, Stockholm and Filipstad. The age of the participants ranged between 17 and 21 years, and mean age was 18 (±0.7) years, 198 were girls and 123 boys, five people did not answer the question or did not perceived themselves as either one of the options. The participants answered questions with response sets about the quality of their social support and the size of their social network and perceived physical and mental health. After that, observations were completed to find eventual correlations between the different factors. Participants for this study were selected on a non-random, somewhat typical, conveniences based method. Results Significant positive correlations were observed between the degree of social support (quality) and perceived mental and physical health Strongest correlation was found between mental health and social support (r = 0,46). Low positive correlation was found between the number (quantity) of friends (r = 0,19) and family/relatives (r = 0,19) in relation to mental health, and in relation to family and relatives also the physical health (r = 0,14). No significant differences were seen between the sexes. Conclusion The study’s hypothesis of a positive correlation between perceived health and social support and network sued in most cases, and the quality was shown to be superior to the quantity.

This study assessed the effect of variables such as life satisfaction, self-rated health, social support and coping styles on subjective well-being. The level of subjective well-being was studied in a sample of Mexican elderly persons from the state of Yucatan in Merida (n = 122) with an age range of 60-93 years. The results in women show that coping styles predicts subjective well-being in negative affects. Moreover, self-perception of health, coping styles, and satisfaction with life are adequate predictors of the cognitive dimension of subjective well-being. Results in men show that satisfaction with life and coping styles predict the cognitive dimension of subjective well-being. Findings point to the importance of exploring psychosocial variables in older adults. / El presente estudio evaluó el efecto de las variables satisfacción con la vida, autopercepción de salud, apoyo social y estilos de enfrentamiento sobre el bienestar subjetivo. Se contó con una muestra de 122 adultos mayores mexicanos del Estado de Yucatán, en la ciudad de Mérida con un rango de edad de 60 a 93 años. Los resultados en mujeres muestran que los estilos de enfrentamiento son predictores del bienestar subjetivo en los afectos negativos. En cuanto a la dimensión cognitiva del bienestar subjetivo, la autopercepción de salud, los estilos de enfrentamiento y la satisfacción con la vida fueron predictores adecuados. En hombres, los resultados demuestran que la dimensión cognitiva del bienestar subjetivo fue predicha a partir de la satisfacción con la vida y los estilos de enfrentamiento. Los hallazgos muestran la importancia del profundizar y promover variables psicosociales en los adultos mayores. / Cette étude a évalué l’effet de la satisfaction de la vie, de l’auto-perception de la santé, du soutien social et des styles d’adaptation sur les variables de bien-être subjectif. Nous avons étudié le niveau de bien-être subjectif d’un échantillon de 122 Mexicains âgés de l’État du Yucatan, dans la ville de Mérida, âgés de 60 à 93 ans. Les résultats chez les femmes montrent que les styles d’adaptation sont des facteurs prédictifs du bien-être subjectif des affects négatifs, en termes de la dimension cognitive du bien-être subjectif, l’auto-perception de la santé, les styles de confrontation et de satisfaction avec la vie étaient des prédicteurs adéquats, tandis que chez les hommes, les résultats montrent que la dimension cognitive du bien-être subjectif est prévu de satisfaction de la vie et les styles d’adaptation. Les résultats montrent l’importance d’approfondir et de promouvoir les variables psychosociales chez les personnes âgées. / Este estudo avaliou o efeito de variáveis, satisfação com a vida, autopercepção de saúde, apoio social e estilos de coping no bem-estar subjetivo. o nível de bem-estar subjetivo foi estudado no estado de uma amostra de adultos mexicanos mais antiga do Yucatan em Merida (n = 122) com uma faixa etária de 60-93 anos. Os resultados em mulheres mais antiga mostram que os estilos de enfrentamento são preditores de bem-estar subjetivo em efeito negativo em termos da dimensão cognitiva do bem-estar de saúde subjetiva auto-avaliação, estilos e satisfação com a vida de enfrentamento foram preditores adequados em homens mais antiga resultados mostram que a dimensão cognitiva do bem-estar subjetivo está previsto a partir de satisfação com a vida e estilos de enfrentamento.